Carlos Guillermo Wiesse, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15548 Issued in TX

Practice address

4116 S Carrier Pkwy Ste 320
Grand Prairie, TX 75052-3243

Phone

(972) 262-5522

Fax

(972) 262-5549

NPI assigned

Aug 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346257177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4116 S CARRIER PKWY STE 320",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523243",
            "telephone_number": "972-262-5522",
            "fax_number": "972-262-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 S CARRIER PKWY STE 320",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523243",
            "telephone_number": "972-262-5522",
            "fax_number": "972-262-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESSE",
        "first_name": "CARLOS",
        "middle_name": "GUILLERMO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "15548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shontell Anita White, AGPCNP
• Shari J Whitehead, RN, IBCLC
• Dai'Kevia Shanpelle Whitfield, LPC
• Victoria Whitham, DPT
• Ralph Thane Wiegman, MD
• Brooke Wiggins
• Brianna Cheyenne Wilcox-Curley
• Shelly Rose Wilkes, LPN
• Graci Wilkins
• William Fan, OD PA

• General Practice Dentistry in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.